Definitive Management of Primary Bladder Tumors in the Context of Metastatic Disease: Who, How, When, and Why?

J Clin Oncol. 2016 Oct 10;34(29):3495-3498. doi: 10.1200/JCO.2016.68.3714.

Abstract

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 70-year-old man with urothelial cancer of the bladder (UBC) metastatic to the pelvic and retroperitoneal lymph nodes was treated with gemcitabine plus cisplatin, but after two cycles neutropenic sepsis developed, which required a prolonged intensive care unit admission. Upon recovery, repeat imaging studies revealed progressive pelvic and retroperitoneal lymphadenopathy, and the patient enrolled in a clinical trial that evaluated treatment with an anti-PD-L1 antibody. The patient achieved a complete radiographic response to immune checkpoint blockade, which continued for 18 months after initiating therapy ( Fig 1 ). However, at that time, a cystoscopy of his primary tumor and a transurethral resection revealed residual muscle-invasive UBC. The patient asked whether there is any role for definitive local therapy of his primary bladder tumor with radical cystectomy or radiation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Algorithms
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • B7-H1 Antigen / antagonists & inhibitors
  • Carcinoma, Transitional Cell / diagnostic imaging
  • Carcinoma, Transitional Cell / secondary
  • Carcinoma, Transitional Cell / therapy*
  • Cisplatin / administration & dosage
  • Cystectomy
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Gemcitabine
  • Humans
  • Immunotherapy / methods
  • Lymphatic Metastasis
  • Male
  • Pelvis
  • Radiotherapy
  • Retroperitoneal Space
  • Urinary Bladder Neoplasms / diagnostic imaging
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / therapy*

Substances

  • B7-H1 Antigen
  • CD274 protein, human
  • Deoxycytidine
  • Cisplatin
  • Gemcitabine